Tuesday, March 24, 2009

The AMA, Ethics, and "404 Not Found"

As I announced last week, the APA (American Psychiatric Association) has voted to phase out pharmaceutical industry funding of CME symposia at its annual meeting. The APA now has bragging rights as the first national medical organization to make this needed reform.

So what's shaking over at the AMA (American Medical Association)? Acting on a tip from Kate Peterson at The Prescription Project's blog, PostScript, I did a little investigating. As some faithful readers may recall, last fall, the AMA's Council on Ethical and Judicial Affairs (CEJA) released a report in which they recommended that doctors and medical institutions "must not accept industry funding to support professional education activities." But when the report was brought before the AMA House of Delegates in November, the representatives of for-profit MECCs (medical education and communication companies) were allowed to speak directly to the committee charged with evaluating the proposal. These MECCs, whose very existence depends on industry funding, were persuasive, and the AMA tabled the proposal (see here for details), asking CEJA to go back to the drawing board.

Since then, some unfortunate things have occurred. First, the excellent CEJA report on industry involvement in medical education has been removed from the AMA website. If you follow the original link, you get an unceremonious "404 Not Found" and "The requested document was not found on this server."

I asked CEJA officials why the document was censored, and received a prompt response from Bette-Jane Crigger, Director of Ethics Policy, that read, in part:

Because the report was referred back and CEJA is continuing its deliberations, the document is not posted to CEJA's Web pages. This is standard practice. The document was available last spring as proposed policy in the Delegates Handbook for the 2008 Annual Meeting of the House of Delegates, not as a CEJA posting per se. So, neither censorship nor anything irregular.

Fair enough. I also asked if I could receive a copy of the report to post on my blog for posterity. The answer was not encouraging:

I rather doubt the Council would favor allowing you to post the prior version of its report, but I will raise the question at our next conference call.

Meanwhile, it appears that the eventual conclusion of the revised ethics report is in little doubt. The AMA has posted a series of "fact sheets" from their National Task Force on CME Provider/Industry Collaboration. There are three in all, plus a "Get the Facts Toolkit." For chuckles and giggles, I suggest you read these documents. They appear to have been written by a pharma-funded public relations firm. Here are some choice excerpts:

The pharmaceutical, biotechnology and medical device industries play a significant role in informing healthcare professionals about the availability, value, and proper use of medications, vaccines, and medical devices.

(Yes, and we call this "advertising").

These industries have adopted voluntary guidelines on interactions with healthcare professionals.

(That's right, with a gun to their heads called the "Physician Payments Sunshine Act").

The company then provides funding in the form of an educational grant to an educational provider, for example a medical school, organization or agency that manages the grant funds and is responsible for ensuring independence from commercial influence. In all cases, the company has no input into the faculty selection or content of the educational activity.

(Except that, if the company is displeased with the faculty or the content, they will choose a different MECC to fund--not that this incentive could possibly lead to any influence over content, of course).

The CME activities that are supported by industry must be unbiased, open to a variety of viewpoints, and must not serve as marketing or promotional vehicles for industry.

(Which is why all industry-funded CME focuses singularly on conditions for which the company markets a product--no "promotion" there).

Ethics are important for the AMA and for all of us. But when ethics comes face to face with $1.2 billion in annual industry funding for CME, we pretty much know how lopsided the battle will be.

“...it’s not pretty; it’s not quality; it’s not American medicine the way it oughta be.”Senator John D. RockefellerWhat is Health Care Quality and Who Decides? Subcommittee on Health CareU.S. Senate Committee on FinanceMarch 19, 2009

Check out Senator Rockefeller’s theory on how political pressures influence decision-making in health care (video clip position 58:01):http://finance.senate.gov/sitepages/hearings.htm

I'm writing a research paper on the topic of CME. As part of this paper I would like to get feedback from physicians via an online survey. I have been having a hard time getting physicians to respond to the link through email. While posting the survey link on a blog isn't the ideal dissemination method, it is in hopes that an interested physician will find this link and participate (please!).

Talk about the ethics of CME sponsorship, and it will just get me going. At least APA has announced today that they will not have any industry-sponsored CME during their annual meetings. But the field has a long way to go, as evidenced by the "CME" activities at some of the premier psychiatric academies:http://www.mghcme.org/?page=organization/supporters